THE NEW YORKER matter remained. Indeed, the more she learned the more her interest grew. Everything about it and its outlawed manipulation excited her. She found herself enjoyably charged with a sense of mission. Her first thrust in that direction was a report of the case of Penny Thomp- son-which she wrote in collaboration with Dr. Stein and two other col- leagues, Dr. Robert Branch and Dr. Philip Johnston-to the Journal of the American Medical Association. It was published in the issue of September 5, 1990. The report, as required, was scrupulously clinical, but it concluded with a word of comment and concern: "Although definitive evidence is lack- ing for the role of canthaxanthin as a cause of the patient's aplastic anemia, the history of onset of symptoms several weeks after the use of canthaxanthin without any other apparent cause sug- gests the association of this toxic effect with canthaxanthin. . . . Since no stud- ies have been carried out in humans to evaluate the safety of canthaxanthin as an oral tanning agent, advertising statements that the drug is harmless have no foundation. More careful in- vestigation . . . is needed." The publication of "Aplastic Ane- mia Associated with Canthaxanthin Ingested for 'Tanning' Purposes," as the article by Dr. Bluhm and her asso- ciates was titled, attracted wide and serious attention. Responses to it ranged from an anecdotal note from a physician in Florida to a "Talk Paper," or position report, headed "Update on Tanning Pills," from the Food and Drug Administration. The physician introduced himself as an avocational canary breeder. He wrote that he had conceived the idea of feed- ing canthaxanthin to his birds in the hope of producing a brilliantly red- feathered variant strain. He said that he had had one or two successes, but that several of his canaries that were fed canthaxanthin had died of a wast- ing blood disease. The lAMA report, he wrote to Dr. Bluhm, would seem to have eXplained those deaths. The F.D.A. "Talk Paper" was dated Oc- tober 1st and began, "F.D.A. contin- ues to warn consumers that cantha- xanthin-the major ingredient in tan- ning pills-has not been approved by the agency as safe for this or any other cosmetic use. Such products are illegal. The agency ad vises that state- ments claiming the ingredient has been approved are misleading. The in- gredient has been approved, at very low levels, for coloring some foods and drugs, but not, at any level, for tanning purposes. . . . The 1960 Color Addi- tive Amendments require manufactur- ers to petition F.D.A. to approve each proposed use of a color additive. Legal- ly, all color additives are considered unsafe unless data prove otherwise." The case reported by Dr. Bluhm and her associates was not the first canthaxanthin tanning-pill complaint to come to the F.D.A.'s attention. A young woman became seriously ill after taking tablets every day for two months. Her illness was diagnosed as drug-induced hepatitis. A man devel- oped welts and severe itching after taking only eight tablets. Penny Thompson's aplastic anemia was mere- ly the first such case on record. " 1 WENT down to one of our health-food stores the other day," Dr. Bluhm told me. "Canthaxanthin had made me very curious about that sort of place, the sort of place where you can buy tanning tablets. I wanted to see their display of drugs. There are, of course, drugs and drugs. The drugs that most of us are familiar with are what I call ethical drugs. I use that term to describe both prescription drugs and over-the-counter drugs. They dif- fer, generally speaking, in only one respect: prescription drugs require the authorization of a physician. But both are equally safe, both have been tested and approved by the F.D.A. for certain specified uses. Then, there are what I call non-ethical drugs. Some of these, like canthaxanthin, have been declared illegal for any but a designated use. But most of them are simply non-legal. There are probably many hundreds of them, but they don't exist in any stan- dard index or pharmacopoeia. Their effectiveness or ineffecti veness-even their toxicity-has never been scientif- ically established. They form a sort of gray area that has always interested me, but canthaxanthin made me really con- cerned. The truly illicit drugs don't t.?iJ (Nt?; IJ tf 0 :j a ijJ' IJ I i,J 73 interest me in the same way. Heroin, cocaine, LSD, an those. The people who take those drugs know what they're doing. And they take them not only for an expected result. Their adrenaline is turned on by more than the drug itself. They know there is a risk-anything might happen-and that risk is part of the experience. There is an excitement in a jump into the unknown. But, as I say, this is not my main concern. My main concern is for the unsophisticated, the innocent, the ignorant and gullible people who go to the health stores in the hope of improving their health. "The store I went to was doing a good business. I suppose they all do. I browsed along the shelves. The drugs and food supplements and tonics all had labels and names and usually some suggestion of purpose. But that was it. There was no real information. Canthaxanthin tanning pills were on display, and a reporter I know on one of the local papers later told me there were also a number of tanning parlors around town where they were featured. Well, I asked the clerk about some of the things they stocked. He shook his head. He didn't know. He said he just worked there. I wish I had taken some good notes. But I have an advertise- ment from some magazine or paper that tells the same story." Dr. Bluhm shuffled through her folder and pulled out still another clip- ping. She spread it out on her desk. It was a full-page listing of countercul- ture pharmaceuticals that could be ob- tained from a nameless 800 number. It told a story, all right. And a sad one. The page was headed "JBN KEEPS YOU AND YOUR WALLET IN SHAPE." The first item on the list was "Aminobolic P.M., 14 Day, $9.99." Another was "Good Life Mega Pack," at the same price. There was a "Victory Coenzyme Q-10," priced at $17.39 for "100 caps." There was "Life Essence Ami- no Caps," for only a few cents more. There was "Victory Smilax & Siberian Ginseng, 180 caps, $7.19." There was "Victory Ferulic Acid, 60 caps, $12.59." And a good dozen more. Bodybuilders all. "You will notice that none of them are described," Dr. Bluhm said. "There are no claims, except by impli- cation. The names sound beneficial, and scientifically impressive. People have heard of the amino acids. They may not know precisely that they are